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General NPI Number Information
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NPI Number | 1417692625
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Entity Type | Individual
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Provider Name | CHAQUITA INGRAM COUNSELOR
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Gender | Female
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 2690 SOMERSET DR APT Z307
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-9475
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Country | US
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Telephone | 561-709-9436
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Fax |
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Provider Business Mailing Address
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Address Line | 2690 SOMERSET DR APT Z307
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-9475
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Country | US
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Telephone | 561-709-9436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | FTCA-CLI-1024-430
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License Number State | FL
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